AMERICAN JOURNAL OF OPHTHALMOLOGY PUBLISHED MONTHLY BY THE OPHTHALMIC PUBLISHING COMPANY

E D I T O R I A L S T A F F LAWRENCE T. POST, editor

524 Metropolitan building, Saint Louis WILLIAM H. CRISP, consulting editor

530 Metropolitan building, Denver EDWARD JACKSON, consulting editor

1120 Republic building, Denver HANS BARKAN

Stanford University Hospital, San Fran­cisco

HARRY S. GRADLE 58 East Washington street, Chicago

H. ROMMEL HILDRETH 824 Metropolitan building, Saint Louis

PARK LEWIS 454 Franklin street, Buffalo

M. URIBE TRONCOSO 350 West 85th street, New York

M. F. WEYMANN 903 Westlake Professional building, Los Angeles

JOHN M. WHEELER 30 West Fifty-ninth street, New York

Address original papers, other scientific communications including correspondence, also books for review and reports of society proceedings to Dr. Lawrence T. Post, 524 Metropolitan building, Saint Louis.

Exchange copies of medical journals should be sent to Dr. William. H. Crisp, 530 Metropolitan building, Denver.

Subscriptions, applications for single copies, notices of change of address, and com­munications with reference to advertising should be addressed to the manager of subscrip­tions and advertising, 50S Metropolitan building, Saint Louis. Copy of advertisements must be sent to the manager by the fifteenth of the month preceding its appearance.

Authors' proofs should be corrected and returned within forty-eight hours to the editor. Twenty-five reprints of each article will be supplied to the author without charge. Additional reprints may be obtained from the printer, the George Banta Publishing Com­pany, 450-458 Ahnaip street, Menasha, Wisconsin, if ordered at the time proofs are re­turned. But reprints to contain colored plates must be ordered when the article is accepted.

T H E F O U R T E E N T H INTERNA­TIONAL OPHTHALMOLOGICAL

CONGRESS Madrid, Spain, April 16, 1933

"Congresses," said Hirshberg, in his History of Ophthalmology "are not planned with the purpose of bringing out new things but rather for an ex­change of opinions with the view to place unsettled procedures on a firmer foundation."

Today the results of research and ex­periment are disseminated with such rapidity that little is left that is original to be offered at quadrennial conferences. These are of great importance, however, in establishing personal contacts be­tween those from widely separated countries, speaking different languages and living under diversified conditions. To hear the voices and to see the faces of those whom we have known only from their published writings is to give a new interest to what they may have to say. Friendships are in this way de­veloped and sympathetic understand­

ings established that would never other­wise have been formed.

The Ophthalmological Congress at Madrid was no exception in this regard. Owing to financial conditions many can­cellations were made by those who had planned to attend ; the number from the United States was only eighteen, while the total registration was between six and seven hundred. Of these, the major­ity were from Spain and the Spanish speaking countries; France and Italy were generously represented. The spirit of the Congress was largely Latin and the language used almost to the exclu­sion of every other was French.

The daily bulletins were in French with brief abstracts of important notices in German and English, and while a willing and capable group of transla­tors and "dactylographe" was prepared to transcribe abstracts or remarks in any of the official languages, it was French that was the currency that was in general circulation and which would pass anywhere.

The Palace Hotel with its great "Sa-634

EDITORIALS 635

Ion de Conference" served admirably for the presentation of papers and addresses and adjoining it was the Exposition Hall, in which interesting and exquisite pathological preparations were on view. One of the most effective of these was that of Columbia University sent by Professor John M. Wheeler. This uni­versity was represented by Drs. Castro-vie jo, Redway and Troncoso.

The planning of such a Congress takes much time in order that it may work smoothly and great credit must be given to the President, Professor Mar­quez, and his unwearying associates, the general secretaries, Drs. Poyales and LaCarrere, to Dr. Castresana, the vice-president of the National Commit­tee of Organization, and other members who seemed to be everywhere present and ready to aid the foreign visitors whenever suggestions or advice could be of help.

The method employed at Amsterdam of assigning a number to each member when his subscription was received was found most practicable at Madrid and each on registering was given a package containing not only notices, assign­ments, invitations, etc.—and the hosts were lavish in their entertainments— but as well, two volumes containing the full papers on the stated subjects, "De­tachment of the retina," "Tuberculosis of the iris and ciliary body," and a third volume with abstracts of all the volun­teer papers that had been received in time to be included.

An exceedingly acceptable addition was a volume containing the photo­graphs of the congressionalists. This will long be treasured as a delightful souvenir of the occasion.

Every detail of the Congress was planned with care. The emblem which was used had a historical significance. The diopter as the unit of refractive power at a distance of one meter was ac­cepted in 1875 by the Ophthalmological Congress at Brassels. It had a precursor, however, for Deco de Valdez in 1623 published a book entitled "Use of glasses for all kinds of sight." He de­scribes "parts of spheres which dimin­ish from a sphere of two yards diameter, that is, one yard radius (a Spanish yard

being a little less than a meter) to an­other having the same diameter as the roundness of the eye." The figure taken from his book showing the curvatures from approximately 1.25 diopters to 36 diopters made a most attractive and in­teresting emblem, which was used for the badges, imprints, etc.

The Congress was inaugurated with no little dignity and ceremony in the Great Hall of the University. Seated in the center of the stage was His Excel­lency, the President of the Spanish Re­public Alcali Zamora and on either side the Minister of Public Instruction, the Minister of Marine, the Director of Hy­giene, the Rector of the University, the Dean of the Faculty of Medicine, and Professors Vander Hoeve and Marquez.

Professor Vander Hoeve, the Presi­dent of the International Council, after respectfully saluting the head of the Spanish nation and other dignitaries, recalled with emotion those who had passed on since the meeting in Holland four years before. Among these was the late President of the Council whose place the orator ocupied, Dr. Luns-gaard; and Teacher Collins, who had labored so constantly for international rapprochement, as well as the revered Fuchs, Axenfeld, Roselli and others. At the request of the speaker all stood for a moment in silence in memory of those who had gone before.

"But", he continued, "life goes on and we must look before us." In the name of the Council he extended greeting and welcome to those present, successively in French, English, German, Italian and Spanish. Felicitous responses were made by representatives of various countries who were seated upon the stage. Among those were Professor Ter­rien, Sir John Parsons, Walter Parker, Ovio, Kruckmann, Van Duyse, De-maria, Nordenson, Oguchi, Sousa, Szy-manski and Von Grosz.

The Minister of Instruction, Fernan­do de los Rios, then declared the four­teenth Ophthalmological Congress opened.

A memorable feature of the opening session was the receipt of a letter from the venerable histologist to whom we owe our basic knowledge of the anato-

636 EDITORIALS

my of the retina, Professor Ramon y Cajal, who, because of his weight of years and lack of strength, was unable to be present in person. He promised, however, to embody some of his later observations in a publication which he would send giving a histo-physiologic analysis of some points yet undeter­mined on the architecture of the retina.

As a souvenir of the Congress a beautiful bronze medal with the head of Cajal designed by the great sculptor Benlluire and a sketch of the structure of the retina was presented to each con-gressionalist by the President, Profes­sor Marquez.

The President of the Congress was most happy in his remarks. He recalled that two countries, small in extent though they were, were celebrated for the great names connected with our spe­cialty, Holland and Belgium. It was in the latter that the first ophthalmologic review, "The Annales d'Oculistique" was published in 1838 by Onnier, and it was Warlomont who in 1857 inaugu­rated the first of the series of Con­gresses of which this was the four­teenth.

Holland was the fatherland of Don-ders, of Snellen, of Grotius, of Huygens and Erasmus. To France was accorded the honor of having given birth to Bris-seau who located cataract in the crys­talline and Daviel who made the first extraction. From Germany came Helm-holtz and Graefe and from Italy the pro­fessional descendants and followers of Scarpa and Morgagni and in 1923 the illustrious Albertotti came to Spain to be present at the centenary of Deco de Valdez. He spoke with enthusiastic ap­preciation of the vast host of skillful and able ophthalmologists that were coming from Great Britain and Ireland and the Americas.

Don Alcalâ Zamora is said to be the most eloquent speaker in the Iberian peninsula. Of rather less than medium height, with most expressive features and penetrating black eyes, it may eas­ily be seen how readily he would carry an audience with him. He showed an unusual knowledge and sympathetic un­derstanding of the work which the Con­gress had convened to do "While other

nations are engaged in fratricidal quar­rels urged on by an exaggerated sense of Nationalism, Spain following its an­cient tradition, looks upon all men as brothers. You are come to visit a na­tion that has been passing through a period of blindness but the bandage has been removed from its eyes and today it is firmly fixed on a vital sense of human solidarity." In the name of the people he extended his greeting.

At the Congress held in Holland four years ago the number of volunteer pa­pers that was offered was an embarass-ment of riches. About three hundred au­thors had sent in communications. These were of course, of· varying value but in order that all might be read, or at least abstracted, three conferences were held coincidentally. I t was impos­sible, therefore, when two important subjects were to be presented at the same time that both could be heard by any member of the Congress. To avoid such a conflict of hours, the volunteer papers at Madrid were limited to about fifty and it was arranged that all should have an opportunity of presentation. To accomplish this it was necessary to be­gin at eight-thirty in the morning.

Among the important communica­tions read at that time was one on "Goniascopy, methods and results in glaucoma," by Dr. Troncoso, who also gave several demonstrations of the use of his instrument at the University.

For the first time in the history of Congresses, preventive measures were given a prominent place on the program and the ten o'clock hour was assigned to the International Association for the Prevention of Blindness. In the absence of the president, Professor deLaper-sonne, Dr. Park Lewis presided and Dr. Marin Amat acted as Secretary. The meeting was one of unusual interest; reports were received from the several national committees by their represen­tatives. Speaking for France was Dr. Coutela, for the United States, Dr. Park Lewis, for Belgium, Dr. Van Duyse, for Austria, Dr. A. Fuchs, for Egypt, Dr. El Maziny Bey, for Holland, Dr. Vander Hoeve, for Brazil, Dr. Alvaro, for Bul­garia, Dr. Pascheff, for Spain, Dr. Mar­quez, for Hungary, Dr. von Grosz, for

EDITORIALS 637

Poland, Dr. Zacher, for Portugal, Dr. Moutinho, for Switzerland, Dr. Kenel and for Germany, Dr. Wagenmann.

Professor Marquez read a communi­cation on the necessity of a classification of the causes of blindness. This was sup­plemented by a paper on the same sub­ject by Dr. Marx of Holland.

After an extended discussion a Com­mission was chosen to consider the sub­ject more particularly from a profes­sional standpoint and to report at a sub­sequent Congress. The committee named was Doctors deLapersonne, Park Lewis, Bishop Harmon, Maziny Bey, Marx and Marquez. Equally important and interesting was the session at which Prof, von Grosz was Chairman, given to the League for the Control of Tra­choma.

All of the second day, Tuesday was devoted to the first two main subjects chosen for consideration, "Tubercular uveitis" and "Retinal detachment". The papers on these subjects had been pub­lished in precessional volumes and were already in the hands of the members. The first included a study by E. V. L. Brown on the "Modern treatment of tubercular iridocyclitis," by Igerheimer, one on its pathology and one on its dif­ferential diagnosis. Like the paper on retinal detachment these careful reviews of work done by masters in ophthalmol­ogy mark an era in this age of progress.

The Congress was terminated hap­pily by an excursion to the ancient and historic City of Toledo. The Spanish people were most generous hosts and the fourteenth will be remembered as one of the most successful of the Oph-thalmological congresses. The next Concilium will be held in Cairo four years hence under the presidency of Dr. Sobby Bey-B. Park Lewis.

THE CINCH OPERATION FOR STRABISMUS

This operation was planned by Dr. Roderic P. O'Connor, after serving with a cavalry regiment in the Medical Corps of the U. S. Army, in Arizona. I t was suggested by the method of shortening a saddle girth, commonly used in that

region. The girth is composed of sev­eral strands, and is shortened by loop­ing a rope across each strand. Then by pulling on the rope each strand is looped around it. He first did the operation on a blind, divergent eye, of a Mexican, who desired the improvement of his physical appearance.

This case was reported in the Journal of the American Medical Association, March 2, 1912. A description of the op­eration, with reports of twelve cases, was published in the Ophthalmic Rec­ord in 1912, vol. 23, p. 595, and one in the Archives of Ophthalmology, vol. 43, p. 368. Another description of the opera­tion and its variations, with report of 42 cases appeared in the Transactions of the Section on Ophthalmology of the A.M.A., in 1916, p. 236. It has been no­ticed in the Ophthalmic Year Books for 1912 and 1914, with explanatory illus­trations, and in subsequent volumes. It is well described and illustrated in de Schweinitz Diseases of the Eye, tenth edition, p. 790, but apparently it has not been noticed in the European literature. The operative treatment of squint and heterophoria has never received the at­tention in Europe that it has in the United States.

The principle of the cinch shortening of a tendon, differs from those involved in other muscle operations, like ad­vancement, tendon tucking, resection, or the many elaborate sutures that have been described from time to time. In the System of Ophthalmic Operations, edited by Casey A. Wood, in 1911, there are 28 figures to illustrate the placing of sutures for operations on "extrinsic muscles." There is of course, no men­tion of the cinch operation, because the book was published before Dr. O'Con­nor had described it. He had noticed the great variety of stitches and ligatures, that were being tried to shorten the ex-traocular muscles, and, from their num­ber and complexity reasoned that not one of them could be wholly reliable and satisfactory. He thought the cinch loop­ing was worth trying, and he found it superior to the operations that had pre­ceded it. This is now the general verdict of all surgeons who have given it an in­telligent and extended trial.